The practice of American maternity care customarily uses a series of facilities to cater for the series of events occurring during a mother's hospital stay. Most mothers can expect to be cared for in:
A PREPARATION ROOM WHERE ADMISSION PROCEDURES ARE PERFORMED.
A LABOR ROOM WHERE THEY ARE USUALLY CONFINED TO A CONVENTIONAL HOSPITAL BED, ONE NOT IDEALLY SUITED FOR EITHER LABOR OR DELIVERY. Then, at both an emotionally and physically crucial stage of labor, the mother is transferred to a delivery room. This movement necessitates the interruption of fetal monitoring, constitutes a potentially hazardous transfer from bed to stretcher to table, and creates an inconvenient situation for everyone concerned.
A DELIVERY ROOM WHICH RESEMBLES AN OPERATING ROOM AND CAN, THEREFORE, BE VERY DISCONCERTING TO AN ALERT, UNSEDATED PATIENT. The delivery table, designed during the "twilight sleep" era when all patients were sedated and most underwent forceps delivery, is not suited to today's minimally anesthetized patient who desires personal involvement in a more physiologic delivery. Since the design dictates that the patient undergo delivery with her legs suspended in supports, the conventional delivery table precludes the adoption of the upright or reclining posture. Not only do women who are not restrained tend to seek this posture, but studies have shown that a more upright posture produces both better alignment of the pelvis and more effective labor. Besides being embarrassing to the patient the lithotomy position can produce decreased placental perfusion by compression of the maternal vena cava. The patient's breathing is impaired in this position and she is unable to use her arm, chest and abdominal muscles to full advantage. To allow early mother-child contact, the baby is often placed on the mother's abdomen which, because of the narrowness of the table, is the only available space. From a standpoint of both safety and ease of nursing, this is less than ideal.
THE BABY IS THEN ROUTINELY SENT TO A NURSERY REGARDLESS OF THE NEED FOR ANY SPECIAL CARE, PRIMARILY BECAUSE THE MOTHER IS UNABLE TO CARE FOR HER INFANT WHILE ON THE DELIVERY TABLE. This creates the need for nursery space to care for well babies, deprives the parents of early contact with their child and exposes the baby to the risk of nursery acquired infections.
A RECOVERY ROOM -- USED IN SOME HOSPIALS. Here the mother remains for a short time after delivery.
a post-partum ward, to which they are transferred by stretcher and where they remain for one to three days after an uncomplicated vaginal delivery.
The logistics of this sytem include either five or six different rooms, continuous patient transfers, multiple changes of bedclothes, coordination of information between labor room, nursery and post-partum ward personnel and an impersonal, assembly line experience for the mother.
This disclosure relates to a special purpose hospital bed designed to serve the needs of both the hospial staff and patient during both labor and delivery, as well as during the usual hospital stay following the birth of a child. It provides an all-purpose bed for gynecological and obstetrical purposes, or for other pelvic operations on both male and female patients.
This bed eliminates the need for transferring a patient from one bed to another or from one room to another for various normal procedures. It particularly lends itself to the use of regional anesthesia during birth and adapts well to the needs presented by prepared childbirth programs. It takes into consideration the emotional, physical and aesthetic requirements of the patient, and serves to simplify and expedite childbirth. Its successful utilization in a maternity program should reduce the average hospital stay required by childbirth without compromising the physical needs of both the patient and attending medical personnel.
The bed further provides the patient with the type of support now available in a specialized obstetric chair or "birth chair," where the patient can comfortably assume a seated posture best calculated for successful natural childbirth. Finally, should the need arise, the patient can be placed in the lithotomy position by separating the two bed frame modules to provide adequate exposure for forceps delivery or other reasons.
Single-room short stay maternity care can do more than any other concept to provide safe childbearing at reduced cost. This has been demonstrated in many centers throughout the country, and an increasing number are moving in this direction, with many notable successes. The major impediment to more universal acceptance of this method has been the inability to achieve satisfactory safety for all patients undergoing different complexities of vaginal delivery. Most facilities therefore limit the use of childbearing rooms to only those mothers considered to be at low risk. While their safety record has been generally impressive, there remains the possibility of patient endangerment in the event of a sudden unexpected emergency. This risk, though small, has understandably been the major factor limiting general national adoption of the concept.
The multipurpose childbearing bed disclosed herein makes it possible for all women undergoing either straightforward or complicated vaginal delivery to have the same or greater safety than that previously only attainable in a system of specialized rooms. As the need for cesarean section now constitutes the only absolute contraindication to delivery in a childbearing room equipped with a multipurpose bed, the single-room system can now be safely used by almost 90% of all mothers.
Conservatively, a 30% reduction in hospital maternity costs can be achieved by using a system of short stay childbearing rooms. Far greater savings have been reported by many centers, and these do not yet have multipurpose beds. Regardless of all other benefits mentioned, the possibility of providing better, safer care while reducing the national hospital maternity bill of around four billion dollars deserves consideration.
Already many maternity care centers are proliferating around the country, not because of insufficient hospital space but because hospitals will not provide the type of desired safe care at an affordable cost. If hospitals do not move decisively and soon to become more responsive, this duplication of facilities will inevitably push the cost of hospital care even higher.